IntroductionMachine learning (ML) algorithms have been heralded as promising solutions to the realization of assistive systems in digital healthcare, due to their ability to detect fine-grain patterns that are not easily perceived by humans. Yet, ML algorithms have also been critiqued for treating individuals differently based on their demography, thus propagating existing disparities. This paper explores gender and race bias in speech-based ML algorithms that detect behavioral and mental health outcomes.MethodsThis paper examines potential sources of bias in the data used to train the ML, encompassing acoustic features extracted from speech signals and associated labels, as well as in the ML decisions. The paper further examines approaches to reduce existing bias via using the features that are the least informative of one’s demographic information as the ML input, and transforming the feature space in an adversarial manner to diminish the evidence of the demographic information while retaining information about the focal behavioral and mental health state.ResultsResults are presented in two domains, the first pertaining to gender and race bias when estimating levels of anxiety, and the second pertaining to gender bias in detecting depression. Findings indicate the presence of statistically significant differences in both acoustic features and labels among demographic groups, as well as differential ML performance among groups. The statistically significant differences present in the label space are partially preserved in the ML decisions. Although variations in ML performance across demographic groups were noted, results are mixed regarding the models’ ability to accurately estimate healthcare outcomes for the sensitive groups.DiscussionThese findings underscore the necessity for careful and thoughtful design in developing ML models that are capable of maintaining crucial aspects of the data and perform effectively across all populations in digital healthcare applications.

OBJECTIVE:The erector spinae plane block (ESPB) is a novel regional analgesic technique which improves postoperative outcomes in lumbar surgery patients including length of hospitalization, days to ambulation, and postoperative opioid use. Traditionally, the block is administered by anesthesiologists trained in the ultrasound guidance technique. The use of fluoroscopic guidance may improve the efficiency and accessibility of the ESPB for spine surgeons. We aim to measure the time to administer an ESPB using fluoroscopic guidance and localize the anesthetic using intraoperative three-dimensional (3D) imaging. METHODS:Two neurosurgeons administered an ESPB to patients undergoing lumbar surgery. Time from insertion of the spinal needle to localize the erector spinae plane using C-arm guidance to time of complete injection and removal of the needle from the skin was recorded. One patient underwent O-arm imaging following injection of an Isovue-Exparel solution at the L3 level to visualize spread of the anesthetic. RESULTS:A total of 21 patients were enrolled in this study. The average duration to perform an ESPB under fluoroscopic guidance was 1.2 minutes. The Isovue-Exparel solution was injected at the L3 level and was well distributed along the ESP on intraoperative O-arm imaging. The anesthetic dissected the erector spinae muscle from the transverse process at L2, L3, and L4. CONCLUSIONS:Fluoroscopic guidance allows efficient and appropriate delivery of the anesthetic to the erector spinae plane. Performing an ESPB with fluoroscopic guidance improves efficiency and accessibility of the analgesic technique for spine surgeons, reducing dependence on anesthesiology personnel trained in administering the block.

Background: Changes in the biochemical and protein composition of ocular fluid may reflect inflammation due to disruption of the blood-retinal barrier (BRB), as in uveitis. Tear fluid is studied as a source of biomarker discovery in ocular and non-ocular diseases. Tear sampling is non-invasive and tolerated by children. Objectives: We aim to compare proteins in tears and aqueous humor (AH) of children with and without uveitis. Methods: Our cross-sectional study collected tears and AH in 4 patients with uveitis (1 JIA-uveitis, 1 chronic anterior uveitis, 2 ADNIV) and 3 pediatric non-inflammatory controls. Tears were collected by Schirmer strip, and AH during routine eye surgery. Advanced proteomic strategies (iTRAQ labeling and nanoLC-MS/MS) quantified proteins and normalized by total peptide amount. Log of the mean of the ratios was derived from 2 abundance readings per protein/subject. We used Wilcoxon rank sum exact test to compare proteins in tears and AH of uveitis patients and controls (P-value <0.05). Results: Seven patients (71% females, median age 17 y [R 2-59] at collection) contributed 10 paired tear and AH samples. 145 proteins were identified at medium 95% or higher FDR confidence with at least 1 high confidence peptide. Protein abundance was significantly different in tears vs AH of children with uveitis (median 607.8 vs 5012.0, P value 0.009), but not in controls (median 634 vs 121, P value 0.175) (Figure 1A/1B). Further analysis only included proteins detected in 100% of samples. Proteomic analysis showed significantly different expression of 31 of 63 (49%) proteins in tears and AH of children with uveitis, and of 10 of 18 proteins (45%) in controls (Figure 2A/2B). Some of these proteins have already been reported to be associated with the immune response or as inflammatory markers (Immunoglobulins heavy constant alpha 1, protein S100A9, and lysozyme), in the retinal pigment epithelium (Pigment epithelium derived factor), and in inflammatory uveitis (as vitamin D-binding protein, lactotransferrin, ceruloplasmin or apoliprotein I). Conclusion: Uveitis is a vision-threatening disease that warrants exploration of techniques for early detection. The eye is an immune-privileged organ immunologically shielded by the BRB. Around 50% of proteins overlapped in tear fluid and AH. Of those that were differentially expressed, mammoglobin-B, cystatin-S, and secretoglobin family 1D member have been reported in pediatric uveitis tear biomarker studies. Lysozyme, lactoferrin, lipocalin, albumin, and lactotransferrin are common major tear proteins. As tear sampling is feasible in children compared to AH, use of tears in uveitis biomarker studies is promising. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.Figure 1Differences in protein abundance in children with uveitis 1A and control group 1B Figure 2Significant different protein expression in tears and aqueous humor in children with and without uveitis.

BACKGROUND:Postoperative pain is a barrier to early mobility and discharge after lumbar surgery. Liposomal bupivacaine (LB) has been shown to decrease postoperative pain and narcotic consumption after transforaminal lumbar interbody fusions (TLIFs) when injected into the marginal suprafascial/subfascial plane-liposomal bupivacaine (MSSP-LB). Erector spinae plane (ESP) infiltration is a relatively new analgesic technique that may offer additional benefits when performed in addition to MSSP-LB.OBJECTIVE:To evaluate postoperative outcomes of combining ESP-LB with MSSP-LB compared with MSSP-LB alone after single-level TLIF.METHODS:A retrospective analysis was performed for patients undergoing single-level TLIFs under spinal anesthesia, 25 receiving combined ESP-LB and MSSP-LB and 25 receiving MSSP-LB alone. The primary outcome was length of hospitalization. Secondary outcomes included postoperative pain score, time to ambulation, and narcotics usage.RESULTS:Baseline demographics and length of surgery were similar between groups. Hospitalization was significantly decreased in the ESP-LB + MSSP-LB cohort (2.56 days vs 3.36 days, P = .007), as were days to ambulation (0.96 days vs 1.29 days, P = .026). Postoperative pain area under the curve was significantly decreased for ESP-LB + MSSP-LB at 12 to 24 hours (39.37 ± 21.02 vs 53.38 ± 22.11, P = .03) and total (44.46 ± 19.89 vs 50.51 ± 22.15, P = .025). Postoperative narcotic use was significantly less in the ESP-LB + MSSP-LB group at 12 to 24 hours (13.18 ± 4.65 vs 14.78 ± 4.44, P = .03) and for total hospitalization (137.3 ± 96.3 vs 194.7 ± 110.2, P = .04).CONCLUSION:Combining ESP-LB with MSSP-LB is superior to MSSP-LB alone for single-level TLIFs in decreasing length of hospital stay, time to ambulation, postoperative pain, and narcotic use.

ObjectivesThis study aimed to analyze the role of estrogen in noise-induced hearing loss (NIHL) and uncover underlying mechanisms.MethodsAn ovariectomized Sprague-Dawley rat model (OVX) was constructed to investigate the hearing threshold and auditory latency before and after noise exposure using the auditory brainstem response (ABR) test. The morphological changes were assessed using immunofluorescence, scanning electron microscopy and transmission electron microscopy. Proteomics and bioinformatics were used to analyze the mechanism. The findings were further verified through western blot and Luminex liquid suspension chip technology.ResultsAfter noise exposure, OVX rats exhibited substantially elevated hearing thresholds. A conspicuous delay in ABR wave I latency was observed, alongside increased loss of outer hair cells, severe collapse of stereocilia and pronounced deformation of the epidermal plate. Accordingly, OVX rats with estrogen supplementation exhibited tolerance to NIHL. Additionally, a remarkable upregulation of the thrombospondin 1 (Tsp1)-CD47 axis in OVX rats was discovered and verified.ConclusionsOVX rats were more susceptible to NIHL, and the protective effect of estrogen was achieved through regulation of the Tsp1-CD47 axis. This study presents a novel mechanism through which estrogen regulates NIHL and offers a potential intervention strategy for the clinical treatment of NIHL.

A national hip fracture registry does not yet exist in China. This is the first to recommend a core variable set for the establishment of a Chinese national hip fracture registry. Thousands of Chinese hospitals will build on this and improve the quality of management for older hip fracture patients. The rapidly ageing population of China already experiences over half a million hip fractures every year. Many countries have developed national hip fracture registries to improve the quality of hip fracture management, but such a registry does not exist in China. The study is aimed at determining the core variables of a national hip fracture registry for older hip fracture patients in China. A rapid literature review was conducted to develop a preliminary pool of variables from existing global hip fracture registries. Two rounds of an e-Delphi survey were conducted with experts. The e-Delphi survey used a Likert 5-point scale and boundary value analysis to filter the preliminary pool of variables. The list of core variables was finalised following an online consensus meeting with the experts. Thirty-one experts participated. Most of the experts have senior titles and have worked in a corresponding area for more than 15 years. The response rate of the e-Delphi was 100% for both rounds. The preliminary pool of 89 variables was established after reviewing 13 national hip fracture registries. With two rounds of the e-Delphi and the expert consensus meeting, 86 core variables were recommended for inclusion in the registry. This study is the first to recommend a core variable set for the establishment of a Chinese national hip fracture registry. The further development of a registry to routinely collect data from thousands of hospitals will build on this work and improve the quality of management for older hip fracture patients in China.

PURPOSE:To report 2-year ocular and developmental outcomes for infants receiving low doses of intravitreal bevacizumab for type 1 retinopathy of prematurity (ROP).METHODS:A total of 120 premature infants (mean birthweight, 687 g; mean gestational age, 24.8 weeks) with type 1 ROP were enrolled in a multicenter, phase 1 dose de-escalation study. One eye per infant received 0.25 mg, 0.125 mg, 0.063 mg, 0.031 mg, 0.016 mg, 0.008 mg, 0.004 mg, or 0.002 mg of intravitreal bevacizumab; fellow eyes when treated received one dosage level higher. At 2 years, 70 of 120 children (58%) underwent ocular examinations; 51 (43%) were assessed using the Bayley Scale of Infant and Toddler Development.RESULTS:Correlation coefficients for the association of total dosage of bevacizumab with Bayley subscales were -0.20 for cognitive (95% CI, -0.45 to 0.08), -0.15 for motor (95% CI, -0.41 to 0.14), and -0.19 for language (95% CI, -0.44 to 0.10). Fourteen children (21%) had myopia greater than -5.00 D in one or both eyes, 7 (10%) had optic nerve atrophy and/or cupping, 20 (29%) had strabismus, 8 (11%) had manifest nystagmus, and 9 (13%) had amblyopia.CONCLUSIONS:In this study cohort, there was no statistically significant correlation between dosage of bevacizumab and Bayley scores at 2 years. However, the sample size was small and the retention rate relatively low, limiting our conclusions. Rates of high myopia and ocular abnormalities do not differ from those reported after larger bevacizumab doses.

1Department of Pharmacy, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China 2Pediatric Intensive Care Unit, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China

Low-dose and very low-dose intravitreal bevacizumab (IVB) have been reported to be successful in short-term treatment of type 1 retinopathy of prematurity (ROP), down to an initial dose of 0.004 mg. We now report 12-month outcomes for these infants.Masked, multicenter, dose de-escalation study.One hundred twenty prematurely born infants with type 1 ROP.A cohort of 120 infants with type 1 ROP in at least 1 eye from 2 sequential dose de-escalation studies of low-dose IVB (0.25 mg, 0.125 mg, 0.063 mg, and 0.031 mg) or very low-dose IVB (0.016 mg, 0.008 mg, 0.004 mg, and 0.002 mg) to the study eye; the fellow eye (if also type 1) received 1 dose level higher of IVB. After primary success or failure at 4 weeks, clinical management was at investigator discretion, including all additional treatment.Reactivation of severe ROP by 6 months corrected age, additional treatments, retinal and other ocular structural outcomes, and refractive error at 12 months corrected age.Sixty-two of 113 study eyes (55%) and 55 of 98 fellow eyes (56%) received additional treatment. Of the study eyes, 31 (27%) received additional ROP treatment, and 31 (27%) received prophylactic laser therapy for persistent avascular retina. No trend toward a higher risk of additional ROP treatment related to initial IVB doses was found. However, time to reactivation among study eyes was shorter in eyes that received very low-dose IVB (mean, 76.4 days) than in those that received low-dose IVB (mean, 85.7 days). At 12 months, poor retinal outcomes and anterior segment abnormalities both were uncommon (3% and 5%, respectively), optic atrophy was noted in 10%, median refraction was mildly myopic (-0.31 diopter), and strabismus was present in 29% of infants.Retinal structural outcomes were very good after low- and very low-dose IVB as initial treatment for type 1 ROP, although many eyes received additional treatment. The rate of reactivation of severe ROP was not associated with dose; however, a post hoc data-driven analysis suggested that reactivation was sooner with very low doses.

Anterior segment dysgenesis (ASD) encompasses a wide spectrum of developmental abnormalities of the anterior ocular segment, including congenital cataract, iris hypoplasia, aniridia, iridocorneal synechiae, as well as Peters, Axenfeld, and Rieger anomalies. Here, we report a large five-generation Caucasian family exhibiting atypical syndromic ASD segregating with a novel truncating variant of FOXC1. The family history is consistent with highly variable autosomal dominant symptoms including isolated glaucoma, iris hypoplasia, aniridia, cataract, hypothyroidism, and congenital heart anomalies. Whole-exome sequencing revealed a novel variant [c.313_314insA; p.(Tyr105*)] in FOXC1 that disrupts the α-helical region of the DNA-binding forkhead box domain. In vitro studies using a heterologous cell system revealed aberrant cytoplasmic localization of FOXC1 harboring the Tyr105* variant, likely precluding downstream transcription function. Meta-analysis of the literature highlighted the intrafamilial variability related to FOXC1 truncating alleles. This study highlights the clinical variability in ASD and signifies the importance of combining both clinical and molecular analysis approaches to establish a complete diagnosis.

Previously, we reported intravitreous bevacizumab doses as low as 0.004 mg (<1% of BEAT-ROP dose) were effective in treating type 1 ROP. We now report two-year outcomes after low-dose and very low-dose bevacizumab.

1Department of Pharmacy, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China 2Pediatric Intensive Care Unit, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China

1Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China 2Department of Pharmacy, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China

Understanding the spread of SARS-CoV-2 provides important insights for control policies such as social-distancing interventions and vaccine delivery in the post-pandemic era. In this work, we take the advantage of action tracking reports of confirmed COVID-19 patients, which contain details regarding the mobility trajectory of a patient, along with the people with whom the patient has interacted, the timing of diagnosis, and personal information (e.g., age and sex). We analyzed reports of 4,410 patients from April 2020 to February 2021 in China, a country where the residents are well-prepared for the "new normal" world following COVID-19 spread. We developed natural language processing (NLP) tools to transform the unstructured text of action-tracking reports to a structured network of social contacts. A SEIR model was built on top of the network, and was able to capture important aspects regarding coronavirus transmissions such as location category, age, sex and socioeconomic status. Our analysis provides important insights for the development of control policies. Under the "new normal" conditions, we find that restaurants, locations less protected by mask-wearing, have a greater risk than any other location categories, including locations where people are present at higher densities (e.g., flight). We find that discouraging railway transports is crucial to avoid another wave of breakout during the Chunyun season (a period of travel in China with extremely high traffic load around the Chinese New Year). By formalizing the challenge of finding the optimal vaccine delivery among various different population groups (e.g., sex, age and socioeconomic groups) as an optimization problem, our analysis helps to maximize the efficiency of vaccine delivery under the general situation of vaccine supply shortage. We are able to reduce the numbers of infections and deaths by 7.4% and 10.5% respectively with vaccine supply for only 1% of the population. Furthermore, with 10% vaccination rate, the numbers of infections and deaths further decrease by 52.6% and 78.1% respectively. Our work will be helpful in the design of effective policies regarding interventions, reopening, contact tracing and vaccine delivery in the "new normal" world following COVID-19 spread.

Aims & Objectives: A retrospective chart review of patients treated by tigecycline at the PICU in a Chinese tertiary academic children’s hospital from January 2017 to December 2019. The clinical data were collected to assess the efficacy and safety of tigecycline. Methods: A retrospective chart review of patients treated by tigecycline at the PICU in a Chinese tertiary academic children’s hospital from January 2017 to December 2019. The clinical data were collected to assess the efficacy and safety of tigecycline. Results: 57 patients (aged 0.17-15.2 years) were enrolled in this study, including 25 cases of Klebsiella pneumoniae, 27 cases of Acinetobacter baumannii, 3 cases of Enterobacter cloacae, 1 case of Escherichia coli and 1 case of empirical therapy, diagnosis of septic shock, cSSSI, bacteremia, severe pneumonia, etc. All the patients received a maintenance dose of 1.2 mg/kg q12 h, maximum 50 mg per dose, without a loading dose. Amikacin was the most frequently prescribed concomitant drug. The median duration of tigecycline therapy was 10 days (range, 2-47 days), with a clinical response rate of 83.3 %. No serious adverse drug reactions were detected during the period of medication. Conclusions: Our study showed tigecycline improved efficacy and prognosis for pediatric patients with severe infections, a good tolerance indicating that short-term use is safe. However, pediatric patients receive tigecycline that still is off-label drug use in China, more prospective, randomized, controlled trials are required to objectively evaluate the efficacy and safety of tigecycline in children.

Glucocorticoids (GCs) are generally envisioned as immunosuppressive, but in conditions such as rosacea and perioral dermatitis they can lead to increased skin inflammation. In lung epithelia, GCs promote expression of the proinflammatory cytokine CCL20, which contributes to steroid-resistant asthma. In the skin, CCL20 stimulates inflammation by recruiting T helper 17 T lymphocytes and dendritic cells, and is elevated in papulopustular rosacea. To understand if, and how, GCs affect CCL20 expression in human keratinocytes. CCL20 expression was assessed by quantitative reverse transcriptase polymerase chain reaction and enzyme-linked immunosorbent assay. Selective inhibition of candidate genes and signalling pathways was performed using RNA interference and chemical inhibitors. The binding of activated GC receptor to genomic DNA was determined by chromatin immunoprecipitation, and enhancer activity of genomic sequences was measured with a reporter assay. We found that GC treatment increased CCL20 expression in human keratinocytes and murine skin, both in the undisturbed state and with tumour necrosis factor-α stimulation. GC repressed proinflammatory signalling pathways, including nuclear factor kappa B and p38/mitogen-activated protein kinase, but these inhibitory effects were opposed by the direct binding of activated GC receptor to the CCL20 enhancer, promoting CCL20 expression. Viewed together, these findings demonstrate a mechanism by which GCs induce expression of CCL20 in keratinocytes, which may contribute to the inflammation seen in steroid-exacerbated skin conditions.

Glucocorticoids (GC) are widely used to treat autoimmune and inflammatory skin diseases and are generally envisioned as powerful immunosuppressants. However, in conditions such as rosacea and perioral dermatitis, GCs can paradoxically lead to increased skin inflammation. The molecular mechanisms by which GCs promote inflammation in these clinical contexts are not understood. Recently it was observed that GCs lead to increased expression of the pro-inflammatory cytokine, CCL20, in lung epithelia of steroid-resistant asthma. CCL20 is also expressed at high levels by keratinocytes in papulopustular rosacea, promoting inflammation by recruiting T-lymphocytes and dendritic cells. Here, we investigated how GCs affect CCL20 expression in human keratinocytes. In contrast to suppression of other pro-inflammatory cytokines, treatment of primary human keratinocytes with GCs led to 2 to 3-fold higher expression of CCL20. In addition, while GCs prevented the induction of inflammatory genes in response to tumor necrosis factor-α stimulation, CCL20 expression was amplified even further. Mechanistically, GCs repressed activity of inflammation-related signaling pathways including NFkB and p38/MAPK, but these inhibitory effects were counterbalanced by binding of activated glucocorticoid receptor to the CCL20 enhancer and promoter, which directly induced CCL20 expression. These results indicate that GCs directly promote CCL20 expression and provide new insight to how GCs may contribute to the inflammation observed in steroid-exacerbated and steroid-resistant skin conditions such as rosacea and perioral dermatitis.

Background: Patients with autoimmune disease often require immunosuppressive medications that may increase their risk of developing severe illness from COVID-19. The importance of immunization in this population is particularly high. While the studied vaccines show efficacy in the general population, nothing is known regarding the immune response or safety profile in patients with autoimmune disease and those taking immunomodulatory medications. Objectives: To assess the safety profile and degree of adverse events from SARS-CoV-2 vaccines in patients with autoimmune and inflammatory disease. Methods: This study is part of a larger prospective observational study examining the immunogenicity and safety profile of the SARS-CoV-2 vaccine in patients with immune-mediated diseases taking immunomodulatory medications. Adults with an immune-mediated disease scheduled to receive either a Pfizer or Moderna SARS-COV-2 vaccine were enrolled in this study. Subjects participated in 3 study visits (pre-vaccine, dose 1 (D1) and dose 2 (D2)) where blood, for immunologic assays, and clinical data were collected. Assessments of adverse events (AE), including local and systemic symptoms and validated degree of AE severity were solicited within 7 days of receiving each vaccine dose. Results: To date, 70 patients with autoimmune and inflammatory disease have been enrolled. Demographic and clinical characteristics are shown in Table 1. Distribution of current immunomodulatory medications included prednisone 18.6%, conventional synthetic DMARD 55.7%, targeted synthetic DMARD 4.3%, and biologic DMARD 68.5%. Almost all participants experienced an adverse event following vaccination (D1 96%, D2 100%). Following D1 AEs were generally mild (76.5%) whereas following D2 a large portion of patients experienced AEs that were moderate (47.8%) and severe (30.5%). Injection site pain was the most common AE following both doses followed by arthralgias (D1 21.6%, D2 78.2%), fever (D1 21.6%, D2 70%) and fatigue (D1 21.6%, D2 65.2%) (Figure 1). Figure 1. Solicited Local and Systemic Adverse Events. Percentage of participants who had endorsed an adverse event within 7 days of first or second dose of SARS-CoV-2 Vaccine. ‘Other’ symptoms included chills, blurry vision, brain fog and dizziness. Conclusion: Patients with autoimmune and inflammatory disease experience a significant burden of adverse events following SARS-CoV-2 vaccination with both frequency and severity appearing greater than that of the reported results from the vaccine clinical trials. Several of the endorsed AEs such as fever, fatigue and arthralgias can also be commonly seen in rheumatologic diseases, mimicking flares. While SARS-CoV-2 immunization is crucial in patients with autoimmune diseases, this study demonstrates the importance of understanding the AEs experienced by this patient population to better inform patients of possible expected side effects of SARS-CoV-2 vaccination and further management in the future. Table 1. Demographic and Clinical Characteristics of Participants Parameter N (% ) N=70 Age [years], mean (SD) Age group 48.3 ± 16.4 < 65 53 (75.7) 65+ 17 (24.3) Gender Female 48 (68.6) Male 20 (38.5) Other 2 (2.9) Race White 47 (67.1) Asian 14 (20.0) Hispanic 8 (11.4) Black 1 (1.4) BMI [kg/m2], mean (SD) 25.0 ± 5.4 Immunologic Diagnosis Rheumatoid Arthritis 21 (30.0) Spondyloarthritis* 21 (30.0) Systemic Lupus Erythematous 8 (11.4) Connective Tissue Disease, Other ‡ 12 (17.1) Vasculitis 3 (4.2) Inflammatory Bowel Disease 7 (10.0) Autoinflammatory Syndrome 5 (7.1) Multiple Sclerosis 2 (2.9) IgG4 Related Disease 2 (2.9) Disease Duration [years], mean (SD) 9.0 ± 5 Medications Prednisone 13 (18.6) DMARDs Hydroxychloroquine 16 (22.9) Methotrexate 15 (21.4) Sulfasalazine 6 (8.6) Tofacitinib 3 (4.3) Azathioprine 2 (2.9) Biologics TNF inhibitor 33 (47.1) Rituximab 7 (10) Abatacept 6 (8.6) IL-23 inhibitor 2 (2.9) * Spondyloarthritis includes Axial Spondyloarthritis and Psoriatic Arthritis. ‡ Other Connective Tissue Disease includes scleroderma, Sjogren’s syndrome, polymyositis, and UCTD. Disclosure of Interests: Monica Yang: None declared, Patti Katz: None declared, Diana Paez: None declared, Alexander Carvidi: None declared, Mehrdad Matloubian: None declared, Mary Nakamura: None declared, Lianne S. Gensler Consultant of: AbbVie, Eli Lilly, Gilead, GSK, and Novartis, Grant/research support from: Pfizer and UCB

Pediatric ophthalmologists must stay abreast of current research both within the field of pediatric ophthalmology and strabismus as well as in the global ophthalmology research community at large.

PURPOSE:The purpose is to understand the natural history and physical findings in thyroid eye disease (TED) patients with severe dry eye symptoms (DES). METHODS:Prospective cohort study, studying DES in TED patients over two years. Baseline data included clinical activity score (CAS), time since disease onset, punctate epithelial erosions (PEE), lagophthalmos, superior limbic keratoconjunctivitis (SLK), and marginal reflex distance 1 (MRD1). Ocular Surface Disease Index (OSDI) was utilized to measure symptomatology and scores > 33 (severe) were the primary outcome measure. Multivariate logistic regression was performed on two groups (<9 months, >9 months) to assess if variables change in early versus late disease. RESULTS:88 met the inclusion criteria. 80.7% (n = 71) were female. There were 42 patients in the group with onset of symptoms under nine months and 46 patients over nine months. Mean CAS score was greater under nine months (2.45) than over nine months (1.29) (p < .05).In the multivariate logistic regression for the group presenting with symptoms under nine months, CAS was the only significant predictor of severe OSDI. Every increase in CAS of one yielded a 2.0x increased risk of severe OSDI. For the patients over nine months from onset, PEE was the significant predictor of severe OSDI. PEE was associated with a 5.9x increased risk of severe OSDI. CONCLUSIONS:Severe DES correlate with inflammatory features within the first nine months. Afterward, presence of PEE became more important. DES in TED tends to be a manifestation of orbital inflammation early in disease and exposure later.